Critical Care Obstetrics Education Program earns kudos

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By Marie Sanderson

The Women & Babies Program at Sunnybrook Health Sciences Centre knew change was coming.  It was 2008 and plans were underway to move the hospital’s Women & Babies Program, including a high-risk obstetrics program and level 3 Neonatal Intensive Care Unit, from its downtown Toronto location to the organization’s Bayview campus.  The transition meant a shift to caring for more medically complex obstetrics patients also receiving treatment from Sunnybrook’s brain sciences, cancer, heart, trauma and critical care areas.

Recognizing the change in the patient population that would accompany the move of services in 2010, program leadership identified and planned opportunities for critical care education within the program.  A critical care education program existed at George Brown College for intensive care unit nursing staff.  Eight birthing unit nurses enrolled in this program to enhance their expert obstetrical knowledge.

“I completed the course feeling confident I could meet the needs of patients and their families,” says Leigh Andrews, Advanced Practice Nurse in Sunnybrook’s Women & Babies Program.  “Members of the team can now care for a pregnant woman who also has cardiac or renal disease, or a woman receiving treatment for cancer.”

The education program has been cited as a leading practice in a new report, “Obstetrics Services in Canada: Advancing Quality and Strengthening Safety”, co-authored by Accreditation Canada, Health Insurance Reciprocal of Canada, Canadian Medical Protective Association and Salus Global Corporation.

The overarching goal of the program was to establish an innovative model of care for critically ill women with co-morbidities in the perinatal period.  “A driving force was the desire to maintain the proximity of each woman with her baby or babies,” explains Dr. Jo Watson, Operations Director for the Women & Babies Program, who oversaw the development of the education program.  “Historically, an acutely ill woman would be moved to the intensive care unit or transferred offsite, with their baby or babies remaining in the postpartum unit under the care of their partner and family.”

Program leadership, including Monica Nicholson, Patient Care Manager, consulted with universities and colleges, in addition to networking internally within Sunnybrook to determine the best approach for ensuring staff were prepared to care for pregnant women with complex medical conditions.  A partnership with George Brown College was formed to ensure a relevant and unique curriculum for the hospital’s nurses.

To date, 37 staff, including nurses and educators, have completed the program at George Brown College.  This innovative model of care minimizes multiple transfers to different units, decreasing the potential for knowledge translation errors and enhancing patient safety.

“Day-to-day obstetrical nursing now involves interprofessional case conferences and drawing upon those with expertise in critical care, mental health and cancer,” says Leigh Andrews.  “I’ve seen firsthand the boosted morale among staff who have taken ownership of creating a safe environment for our patients and families.”

Formal surveying found 100 per cent of nurses who completed the critical care course changed their nursing practice.  The nurses also reported higher confidence, improved critical thinking and decreased anxiety when caring for critically ill patients.

Leigh recalls a woman, 28 weeks pregnant, who presented in triage with a fever.  Both mother and baby were declining quickly, with an eventual diagnosis of meningitis and septic shock, and the baby was delivered by emergency Caesarian section.  During her eight days in the cardiovascular intensive care unit, under induced coma for five days, the patient was seen by an interprofessional team including obstetrical nurses working alongside neurology and critical care to ensure breastfeeding support and postpartum care.

“A poignant moment was witnessed by the entire team from several areas of clinical focus.  The mother was in a decreased state of consciousness and the baby was placed on her skin-to-skin,” says Leigh Andrews.  “Her arm automatically came up around her baby and her vital signs settled.”

This case, and many others, spurred the hospital to create an innovative corporate policy to facilitate mothers and babies staying together, as well as a policy on supporting breastfeeding for women who are hospitalized and acutely ill.

“This recognition by Accreditation Canada for the development of a formal process enabling an interprofessional team to care for complex patients is extremely gratifying,” adds Dr. Jo Watson.  “Sunnybrook will continue to develop innovative practice to enhance the care and management of critically ill obstetrics patients.”

Marie Sanderson is a communications adviser at Sunnybrook Health Sciences Centre.